BioMed, Volume 3, Issue 2 (June 2023) – 9 articles

The rapid spread of the new coronavirus disease (COVID-19) caused by SARS-CoV-2 has become a global pandemic. Although specific vaccines are available and natural drugs are being researched, supportive care and specific treatments to alleviate symptoms and improve patient quality of life remain critical. Chinese medicine (CM) has been employed in China due to the similarities between the epidemiology, genomics, and pathogenesis of SARS-CoV-2 and SARS-CoV. Moreover, the integration of other traditional oriental medical systems into the broader framework of integrative medicine can offer a powerful approach to managing the disease. Additionally, it has been reported that integrated medicine has better effects and does not increase adverse drug reactions in the context of COVID-19. This article examines preventive measures, potential infection mechanisms, and immune responses in Western medicine (WM), as well as the pathophysiology based on principles of complementary medicine (CM). The convergence between WM and CM approaches, such as the importance of maintaining a strong immune system and promoting preventive care measures, is also addressed. Current treatment options, traditional therapies, and classical prescriptions based on empirical knowledge are also explored, with individual patient circumstances taken into account. An analysis of the potential benefits and challenges associated with the integration of complementary and Western medicine (WM) in the treatment of COVID-19 can provide valuable guidance, enrichment, and empowerment for future research endeavors. Full article

Despite the availability of vaccines and antivirals and the biological evolution of SARS-CoV-2, the rate of hospitalizations and deaths from COVID-19 remains high in Italy. It is crucial to understand whether and how the clinical characteristics of patients hospitalized for COVID-19 have changed over 2021–2022 and which risk factors are currently associated with adverse outcomes to develop targeted interventions. In this study, we present and compare the characteristics and outcomes of 310 patients with COVID-19 who were hospitalized between 1 August and 9 December 2021, when the Delta SARS-CoV-2 variant was prevalent (Group A), and between 3 January and 30 June 2022, when the Omicron variant was predominant (Group B). Using Survival Analysis, we estimated the cumulative 28-day hazard ratio (H.R.) of Intensive Care Unit (ICU) admission/death of patients in Group B vs. A. We built uni- and multivariate Cox regression models for the overall population and each group to identify risk factors for ICU admission/death among patient features. We found that Group B had a comparable risk of ICU admission/death (HR 1.60, 95% Confidence Interval, C.I. 1.00–2.58, p = 0.05) but a higher prevalence of elderly and co-morbid subjects than Group A. Non-invasive ventilation requirement was associated with adverse outcomes in both Group A (HR 21.03, 95% C.I. 5.34–82.80, p < 0.001) and Group B (HR 4.53, 95% C.I. 2.39–8.59, p < 0.001), as well as in the overall population (HR 3.88, 95% C.I. 2.49–6.06, p < 0.001). During the Omicron wave, elderly and co-morbid subjects had the highest risk of hospitalization and poor outcomes. Full article

The COVID crisis of the past three years has greatly impacted stakeholder relationships between scientists, health providers, policy makers, pharmaceutical industry employees, and the public. Lockdowns and restrictions of civil liberties strained an already fraught relationship between the public and policy makers, with scientists also seen as complicit in providing the justification for the abrogation of civil liberties. This was compounded by the suppression of open debate over contentious topics of public interest and a violation of core bioethical principles embodied in the Nuremberg Code. Overall, the policies chosen during the pandemic have had a corrosive impact on public trust, which is observable in surveys and consumer behaviour. While a loss of trust is difficult to remedy, the antidotes are accountability and transparency. This narrative review presents an overview of key issues that have motivated public distrust during the pandemic and ends with suggested remedies. Scientific norms and accountability must be restored in order to rebuild the vital relationship between scientists and the public they serve. Full article

Machine learning is being increasingly applied in various aspects of medicine. The availability of large amounts of digital health records has enabled researchers to apply machine learning algorithms to tackle different medical problems. Urinary tract infections (UTIs) are common bacterial infections that are prone to being misdiagnosed and over-treated with antibiotics. For appropriate tailored antibiotic therapy, new diagnostic methods providing rapid pathogen identification and antibiotic susceptibility testing are urgently needed. In this review, we first discuss emerging technologies that have employed machine learning models to deliver speedy diagnostic results, particularly for urinary tract infections. We then explore how machine learning models are enabling sequence-based diagnostics by predicting antibiotic resistances from genome sequencing data. Finally, we examine different studies that apply machine learning to electronic health records to improve UTI diagnosis, to reduce antibiotic use and guide treatments without urine culture, and to reduce clinical workload and unnecessary hospital visits. Full article

Baricitinib, a reversible Janus-associated kinase-inhibitor, is approved for treating COVID-19, combined with Dexamethasone and, eventually, with Remdesivir (RDV). This retrospective cohort study assesses the real-life advantages and limits of Baricitinib in the current pandemic scenario. Data of all patients consecutively hospitalized with moderate/severe COVID-19 between 1 October 2021 and 31 March 2022 were retrospectively collected and described according to the treatment received (Baricitinib, Baricitinib + RDV, none). We performed survival analyses to estimate the 21-day probability of Intensive Care Unit (ICU) admission, death, and composite. We built multivariate Cox regression models to identify ICU admission/death predictors among patients’ features. Of 111 subjects, 28 received Baricitinib, 21 received Baricitinib + RDV, and 62 could not be treated due to pre-existing conditions. Treated patients had a comparable risk of death (HR 0.50, 95% C.I. 0.20–1.26, p = 0.14) but remarkably lower risk of 21-day ICU admission (H.R., 0.10, 95% C.I., 0.01–0.86, p = 0.03), regardless of the type of treatment received. At multivariable analysis, older age was the only predictor of ICU admission/death (HR 1.14, 95% C.I. 1.03–1.26, p ≤ 0.01).Although effective, the high prevalence of elderly, co-morbid patients limits Baricitinib use in the current pandemic setting. Full article

Background: A number of corticosteroids are commonly used to treat COVID-19 infection. The aim of this retrospective study was to compare various hospital outcomes among mechanically ventilated COVID-19 patients in an ICU, who were administered either dexamethasone or methylprednisolone. Methods: A total of 121 mechanically ventilated COVID-19 patients from the ICU were included in the analysis, of which 43.8% (n = 53) received methylprednisolone, while 56.2% (n = 68) received dexamethasone. Results: In-hospital mortality (p = 0.381) and hospital length of stay (p = 0.307) were lower among the methylprednisolone group, compared to the dexamethasone group, though not significantly. Survival analysis showed that there were no significant differences between the methylprednisolone and dexamethasone groups (p = 0.978). A Cox proportional regression analysis showed that in-hospital mortality was lower among COVID-19 patients receiving methylprednisolone, compared to the dexamethasone group, though not significantly (hazard ratio (HR), 0.64; 95% CI: 0.35–3.17). Conclusion: Our study showed that in-hospital mortality was lower and hospital length of stay was higher among COVID-19 patients receiving methylprednisolone, compared to dexamethasone. These findings could have been due to the small sample size and limited scope of the study. Therefore, future large-scale studies should evaluate and confirm the findings in this study. Full article

Introduction: Alcohol and other drug (AOD) treatment services were required to rapidly adapt delivery of care in response to the coronavirus (COVID-19) pandemic. This study examined longitudinal changes in the delivery of AOD counselling in Australia over 21 months (October 2019–July 2021) before and throughout the pandemic, using both staff self-report and service data. Methods: Treatment staff from a large AOD service in Queensland, Australia provided self-report data on time spent delivering counselling via face-to-face, outreach (home visits), telephone, and virtual (video) formats. Two waves of online questionnaires were collected, with staff reporting on their time before the pandemic (retrospectively for October 2019–February 2020); during the first lockdown period (retrospectively for March–May 2020); when restrictions were initially eased (June–September 2020); and one year later (July 2021). Service records of the number of counselling episodes conducted by each treatment modality were extracted between October 2019 and July 2021, and analysed by month. Results: Staff (n = 117) and service records indicated an increase in telephone-delivered AOD counselling during the first lockdown, alongside an increase in total counselling records. Telephone-delivered counselling was still significantly higher one year later. Face-to-face counselling declined after the onset of the pandemic, but increased quickly when restrictions were eased. Outreach counselling decreased during the first lockdown. Virtual counselling remained negligible throughout. Conclusion: AOD treatment services quickly utilised telephone counselling options at the start of the pandemic, and demonstrated continued utilisation of this method one year later. Increased virtual (video) counselling was not observed and may be due to limited infrastructure, staff training, and clients lacking Internet connectivity or technology required. Full article

Background: Timely recognition of high-risk individuals with novel Coronavirus disease (COVID-19) is important. Yet, validated risk scores for kidney transplant recipients with COVID-19 are lacking. The present study aimed to externally validate the novel ImAgeS risk score in this population. Methods: A retrospective analysis of 65 kidney transplant recipients with COVID-19 was conducted. A robust external validation of the novel ImAgeS risk score with respect to 30-day all-cause mortality was performed using regression analysis, discrimination and calibration methods. Results: An overall mortality rate during the study follow-up was 18.5% (N = 12). The ImAgeS risk score showed a statistically significant association with 30-day all-cause mortality (HR 1.04 95% CI 1.00–1.08, p =  0.040). This risk score demonstrated a modest, statistically significant discrimination of all-cause mortality (AUC of 0.679 (95% CI 0.519–0.840, p = 0.027). The calibration of the model was acceptable with a Hosmer-Lemeshow value of 3.74, Harrell’s C concordance index of 0.699 and Somers’ D of 0.397. Conclusions: The ImAgeS risk score demonstrated a significant association with 30-day all-cause mortality in kidney transplant recipients with COVID-19. The model showed modest discrimination and satisfactory calibration, confirming the findings from the computational study. Further studies are needed to determine the utility of the ImAgeS score in this high-risk population. Full article

In the early months of the outbreak (2020–2022), COVID-19 was responsible for acute respiratory distress syndrome (ARDS) and an exceptional number of intensive care unit (ICU) admissions. Weaning difficulties from invasive mechanical ventilation (IMV) and many deaths related to COVID-19 were associated with persistent pulmonary hyperinflammation leading to pulmonary fibrosis and sometimes, in the first wave of the pandemic and before the use of dexamethasone was introduced, pulmonary cystic necrosis. A 72-year-old man hospitalized with severe COVID-19 required IMV and died on day 31 of refractory ARDS. Postmortem examination of the lungs found obliterative endotheliitis proximal to pulmonary cystic necrosis. The presence of SARS-CoV-2 envelope and complement/lectin (MASP-2) deposits near the endotheliitis lesions suggested that the virus acted directly on vascular involvement by a complement-mediated mechanism. Together with classic features of ARDS (epithelial lesions and diffuse alveolar damage), endothelial involvement with endotheliitis was the hallmark of severe COVID-19. Corticosteroids and complement blockade were sometimes beneficial for treating severe COVID-19, perhaps by preventing microvascular damage. Full article